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By summer 2021 moderate to exceptional drought impacted 28% of North America, focused west of the Mississippi, with serious impacts on fire, water resources, and agriculture. Here, using reanalyses and SST-forced climate models, we examine the onset and development of this southwestern drought from its inception in summer 2020 through winter and spring 2020/21. The drought severity in summer 2021 resulted from four consecutive prior seasons in which precipitation in the southwest United States was the lowest on record or, at least, extremely dry. The dry conditions in summer 2020 arose from internal atmospheric variability but are beyond the range of what the studied atmosphere models simulate for that season. From winter 2020 through spring 2021 the worsening drought conditions were guided by the development of a La Niña in the tropical Pacific Ocean. Decadal variability in the Pacific Ocean aided drought in the southern part of the region by driving the cool season to be drier during the last two decades. There is also evidence that the southern part of the region in spring is drying due to human-driven climate change. In sum the drought onset was driven by a combination of internal atmospheric variability and interannual climate variability and aided by natural decadal variability and human-driven climate change. [ABSTRACT FROM AUTHOR]